Karine Bertrand

In recent decades, the concept of “trauma” has been embraced in mental healthcare with “trauma-informed” approaches increasingly used to guide treatment. The turn to “trauma” is also evident in the alcohol and other drug (AOD) treatment sector, where it imbues understandings of AOD-related problems, including addiction and overdose. In this article, we combine feminist analyses of mental health with narcofeminist scholarship to analyze trauma as a paradigm for understanding AOD-related concerns. Drawing on interview data from a study of addiction-recovery trajectories conducted across France, Belgium, and Canada, we consider the role of “trauma” discourse in how people with AOD-related issues interpret diverse experiences of suffering. Our participants’ accounts demonstrate that trauma provides a valuable lens for rendering experiences of distress legible within a socio-medical frame. However, we suggest that while trauma-informed therapeutic practices are a welcome move in acknowledging the sociocultural context of suffering, they do not sidestep the pathologizing effects of locating dysfunction in the individual. Moreover, the notion of trauma is often mobilized in medical discourse to characterize women, gender, and sexual minorities as uniquely vulnerable to AOD-related issues due to their risk of experiencing gendered violence. While such explanations highlight how gender and sexuality are imbricated in trauma, they implicitly reinforce a pathologizing view of drug use among women and sexual minorities, overlooking its potential affordances. In making this argument, we consider the broader sociopolitical implications of the turn to trauma in AOD care, including its possibilities and limits for challenging drug-related stigma and discrimination.

Background: The opioid overdose crisis currently affecting Canada has resulted in thousands of deaths, and the COVID-19 pandemic has exacerbated the consequences of this crisis, particularly through the instability of the unregulated drug market. The province of Quebec is observing a similar pattern: the opioids consumed are more dangerous, and the number of overdoses is rising. Opioid use disorder (OUD) therefore represents a major public health issue. Offering appropriate interventions, such as opioid agonist therapy integrated into primary care, is one strategy to reduce the risk of death from overdose. Objective: The aim of this research is to evaluate the implementation of an outreach clinic offering a low-threshold treatment program for OUD in Quebec. The secondary objective is to identify the factors that foster the participation in primary care research of people who are socially excluded and have current or past lived experience of OUD. Methods: This study is being conducted in the Montérégie region of Quebec and comprises 3 phases: exploratory, photovoice, and participatory evaluation. The qualitative research adopts a participatory approach by involving people who are socially excluded and targeted by the outreach clinic’s services (eg, people experiencing homelessness and living with OUD). A committee of peer researchers, made up of experts with current or past lived experience of OUD, will be set up and will hold 10 meetings at various stages of the research. Two participant profiles will be involved: (1) health care professionals and community workers, who will take part in semistructured interviews; and (2) people with current or past lived experience of OUD, who will take part in the photovoice sessions or peer researcher committee meetings. Results: The peer researcher committee was formed in winter 2024, and 10 meetings had been held as of June 2025. As of August 2025, 4 photovoice sessions had been conducted, and 14 health care professionals and community workers had participated in the semistructured interviews. This study was funded in September 2022, with funding available through March 2025. Data were collected from September 2022 through June 2025. The analysis was finished in spring 2025. Results of the study are expected to be published in winter 2026. Conclusions: The anticipated outcome is the establishment of an outreach clinic for OUD outside a major urban center, with a range of services tailored to the needs of people who are socially excluded and living with OUD. The coconstruction of this clinic in collaboration with people with current or past lived experience of OUD will enable an adequate response to the targeted population’s overall health needs and help reduce the barriers to access that they may face in conventional care structures. International Registered Report Identifier (IRRID): DERR1-10.2196/72457

Problematic substance/gambling use has major harmful effects on both members of a couple and on their relationship. It is also exacerbated by couple distress. However, for a person with an addiction (PA), the desire to maintain the relationship and the partner’s support are strong sources of motivation and reinforcement for change and recovery. Although research has shown for decades that couple therapy is an effective way to treat addiction, services are focused largely on individual treatments (Ariss and Fairbairn, Consult Clin Psychol 88:526–40, 2020). The first part of this chapter reviews the literature to provide a brief description of the interactions between problematic use and couple relationships and of effective models of couple treatment for addiction, along with their limitations. The second part of the chapter delves more deeply into Integrative Couple Treatment for Addiction, an approach developed by the authors of this chapter. It focuses on assessment and intervention strategies designed for integrating partners of persons with an addiction (PPA) into couple treatment. Specific issues of addiction treatment with couples and observations on the obstacles to disseminating and implementing couple treatments in real-life settings are briefly addressed.

BACKGROUND The opioid overdose crisis currently affecting Canada has led to several thousand deaths. The COVID-19 pandemic has exacerbated the consequences of this crisis, particularly with the instability of the unregulated drug market. Québec is observing a similar trend: the opioids consumed are more dangerous, and the number of overdoses is rising. Opioid use disorder (OUD) therefore represents a major public health issue. Offering appropriate interventions such as opioid agonist therapy integrated into primary care is one way of reducing the risk of death from overdose. OBJECTIVE The aim of this research is to evaluate the implementation of an outreach clinic offering a low-threshold treatment program for opioid use disorders in Québec. The secondary objective is to identify the factors that foster the participation of socially excluded people living or having lived with OUD in primary care research. METHODS This study is being conducted in the Montérégie region and comprises three phases: exploratory, photovoice and participatory evaluation. The qualitative research adopts a participatory approach by involving socially excluded people targeted by the clinic services (e.g. people experiencing homelessness and living with OUD). A committee of peer researchers, made up of experts in living with OUD, will be set up and will hold 10 meetings at various stages of the research. Two participant profiles will be involved: (1) healthcare professionals and community workers who will take part in semi-structured interviews and (2) people living with or having lived with OUD, who will take part in the photovoice or peer researcher committee meetings. RESULTS The peer research committee was formed in Winter 2024, and by November 2024, five meetings had been held. As of November 2024, four photovoice sessions had been conducted and 14 healthcare professionals and community workers had participated in the semi-structured interviews. Preliminary results from different phases of this project were presented at the 2023 and 2024 North American Primary Care Research Group (NAPCRG) Conferences, as well as at the 2024 International Society for the Study of Drug Policy (ISSDP) Conference. CONCLUSIONS The anticipated outcome is the establishment of an outreach clinic for opioid use disorders outside a major urban centre, with a range of services tailored to the needs of socially excluded people living with OUD. The co-construction of this clinic in collaboration with people living with or having lived with OUD will make it possible to respond adequately to their overall health needs and reduce the barriers to access that they may face in conventional care structures.

Introduction and Objective As the population ages, understanding the potential risks associated with inappropriate medication use becomes increasingly important. Given the lack of studies in this area, our objective was to study the risk of mortality associated with potentially inappropriate medication use involving opioids in community-dwelling older adults. Methods Data came from a longitudinal study on older adults aged ≥ 65 years recruited in primary care clinics between 2011 and 2013 with an average follow-up of 4.25 years. Older adults were excluded if they used an opioid or had a malignant tumor diagnosis in the year before the study survey. A nested case-control within a cohort of older adults with at least one opioid claim during follow-up was used to evaluate the risk of all-cause mortality. Four controls per case were matched on follow-up time using risk-set sampling, i.e., while still at risk of death when their matched case died. The risk of mortality was estimated using conditional logistic regression analyses. Exposure to potentially inappropriate medication use involving opioids, defined using the Beers 2019 criteria, was assessed from provincial drug claims data in the 0–90 days before death. Results In a cohort of 472 community-dwelling older adults with an incident episode of opioid use, there were 40 cases matched to 160 controls. Exposure to inappropriate medication use involving opioids in the 90 days before death was associated with an increased risk of mortality (odds ratio 6.81, 95% confidence interval 1.69–27.47), after adjusting for potential confounders. Conclusions Exposure to inappropriate medication use involving opioids in the 90 days before death is associated with an increased risk of mortality in older adults. These findings can be used to encourage safer pain management strategies in older adults.

To examine changes in life satisfaction and physical and mental health associated with opioid and potentially inappropriate opioid prescribing (PIOP) among older adults. Secondary data analysis from the Étude sur la Santé des Aînés (ESA)-Services study. The sample consisted of 945 older adults recruited in primary care with available health survey information linked to administrative medical record data. The exposure of interest was categorized as no prescription, opioid prescription, and PIOP, defined using the Beers criteria. Outcomes were self-rated physical health, mental health, and life satisfaction measured at baseline and at a 3-year follow-up. Generalized estimating equations were used to examine 3-year changes in outcomes as a function of opioid prescribing. Analyses were adjusted for covariates relating to health, psychosocial, and sociodemographic factors as well as duration/frequency of opioid prescribing. Analyses were conducted in the overall sample and in non-cancer patients. The sample had an average age of 73.1 years; the majority was Canadian-born (96.3%) while females made up over half (55.4%) the sample. Compared to not receiving an opioid prescription, PIOP was associated with a deterioration in physical health (OR_adjusted = 0.65; 95%CI = 0.49, 0.86), but not mental health and life satisfaction. In non-cancer patients, PIOP was associated with poorer physical health (OR_adjusted = 0.59; 95%CI = 0.40, 0.87) and opioid prescribing was marginally associated with improved life satisfaction (OR_adjusted = 1.58; 95%CI = 0.96, 2.60). PIOP was associated with a deterioration in physical health. Patient-centred chronic pain management and the effect on health and well-being require further study in older adults.

The Resurgence of Indigenous Women in Contemporary Québec Cinema was published in Indigenous Media Arts in Canada on page 173.

Introduction. Les personnes en situation d’itinérance qui consomment des substances psychoactives font face à plusieurs barrières à l’accès aux services généraux et ceux qui leur sont dédiés. Cela les mène, entre autres, à interagir fréquemment avec les services d’urgence, que ce soit avec la police, les services paramédicaux et les urgences hospitalières. Pourtant, ces services sont peu adaptés à leurs besoins. Il est donc important d’identifier des pistes de solutions concrètes pour améliorer la réponse d’urgence offerte aux personnes en situation d’itinérance qui consomment des substances psychoactives. Méthodologie. Ce devis évaluatif combine une analyse des besoins avec une évaluation démocratique délibérative. Un processus collaboratif, dont l’utilisation d’une Technique de recherche d’information par l’animation d’un groupe d’experts (TRIAGE) intersectorielle de 32 participants, a été organisé pour prioriser les solutions selon les différentes parties prenantes, soit les prestataires des services d’urgence, les personnes en situation d’itinérance et les autres acteurs qui gravitent autour d’elles (services spécialisés, milieu communautaire, politique et de la recherche). Résultats. Onze solutions ont été priorisées et classées dans quatre catégories : prévention de l’itinérance, approche à bas seuil, continuité des services et gouvernance. Conclusion. Cette étude a permis d’identifier des solutions concrètes et systémiques qui font consensus et qui pourront être implantées dans des contextes similaires au nôtre.

While the COVID-19 pandemic impacted young adults’ alcohol use patterns, little is known about how changes in alcohol use may differ across different settings. Our objective was to identify and compare factors associated with changes in alcohol use among young adults in Canada and France during the first year of the COVID-19 pandemic. We conducted an online cross-sectional survey in October–December 2020 with young adults aged 18–29 (n = 5185) in Canada and France. In each country, weighted multinomial logistic regressions were performed to identify factors associated with self-reported decrease and increase in alcohol use separately (reference: no change). Respectively, 33.4% and 21.4% reported an increase in alcohol use in Canada and France, while 22.9% and 33.5% reported a decrease. Being 25–29 was a predictor of decrease in Canada, while living away from family was associated with an increase in France. In both countries, participants were more likely to report an increase if they reported depressive symptoms, smoking tobacco, or cannabis use. Conversely, those who had been tested for COVID-19 and those who were highly compliant with COVID-19 preventive measures were more likely to report a decrease. Efforts are needed to develop alcohol use interventions for young adults, including in ways that prioritize those with mental health challenges.